Dipeptidyl peptidase-4 inhibitor treatment could decrease Klebsiella pneumoniae pneumonia in patients with type 2 diabetes

ABSTRACT

Objectives

To investigate the effect of dipeptidyl peptidase-4 inhibitor (DPP4i) for Klebsiella pneumoniae (KP) pneumonia in patients with diabetes.

Patients and methods

Patients newly diagnosed with type 2 diabetes from 2009 to 2012 were recruited for this population-based and observational study. Diabetes complications severity index (DCSI) score and defined daily dose (DDD) were used for analysis. The multivariable Cox proportional hazards models were used to estimate the risk of KP pneumonia by DPP4i use, with adjustments for propensity score. The Kaplan–Meier method with the log-rank test was used to estimate the risk of KP pneumonia for DPP4i users.

Results

34774 patients were included. The incidence rate of KP pneumonia in DDP4i users was 1.51 per 1000 person-years and that for the comparison was 2.25 per 1000 person-years. DDP4i users also had a significantly lower cumulative incidence of KP pneumonia (log-rank test p-value = 0.03). DDP4i users had a significantly lower risk of developing KP pneumonia compared with nonusers (adjusted HR = 0.67, 95% CI = 0.48–0.95).

Conclusions

For public health issue with type2 diabetes and infection, DPP4i use decreased KP pneumonia. Male gender, patients with co-morbidities, patients with higher DSCI score and higher DDD of DPP4i were observed to decrease KP pneumonia infection in our analysis. The possible role of DPP4i causing immunological disturbances should be considered.

KEYWORDS:

• Dipeptidyl peptidase-4 inhibitor (DPP4i)
• klebsiella pneumoniae (KP)
• diabetes
• cohort study

Declaration of interest

The authors declare no conflict of interest.

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

All authors have contributed significantly, and all authors agree with the manuscript content: Conception/Design: Hsin-Hung Chen, Chia-Hung Kao; Provision of study materials: Chia-Hung Kao; Collection and/or assembly of data: All authors; Data analysis and interpretation: All authors; Manuscript writing: All authors; Final approval of the manuscript: All authors.

Additional information

Funding

This study is supported in part by Taiwan Ministry of Health and Welfare Clinical Trial Center (MOHW109-TDU-B-212-114004), China Medical University Hospital (CMU107-ASIA-19); MOST Clinical Trial Consortium for Stroke (MOST 108-2321-B-039-003-), Tseng-Lien Lin Foundation, Taichung, Taiwan. The funders had no role in the study design, data collection and analysis, the decision to publish, or preparation of the manuscript. No additional external funding was received for this study.